RMC Junior Volunteer Application
On-boarding application deadlines are as follows:

Application Deadline Interview Dates Orientation
May 1 May 11-22 June 2-10
September 1 September 11-22 October 2-10

How may I become a junior volunteer?
• Must be 15-17 years of age
• Medical clearance by our employee health services (tuberculosis, drug screening, immunization records and proof of immunity)
• Orientation
• Minimum weekly commitment of 3 hours per week
• Maintain the same schedule for a minimum of 3 months
• Maintain 1-year of service

What do I do as a volunteer?
• Escort patients or visitors to their destinations
• Assist staff by running errands for various departments
• Assist staff in other departments
• Advocate for our hospital to the community

What do I receive from volunteering?
• The knowledge that you have made a difference by helping
• A greater understanding for the healthcare field
• Awards for hours donated
• Letter of recommendation after you have donated a minimum of 140 hours
• Opportunities to take on leadership positions

Today's Date
MM/DD/YYYY
Your answer
Name
Last, First
Your answer
Gender
Date of Birth
MM/DD/YYYY
Your answer
Age
Number only
Your answer
Address
Street, City Zip
Your answer
Best Contact Number
(XXX) XXX-XXXX
Your answer
Text Messages?
Email
Your answer
Name of Parent Guardian
Last, First
Your answer
School Attending
Enter full name
Your answer
Year in school
List organizations/groups you belong to (e.g. school, community etc.)
1) ... 2) ... 3) ... so forth
Your answer
How did you hear about our program?
Limit your response to 1 paragraphs or less
Your answer
Special talents, skills or interests?
Limit your response to 1 paragraphs or less
Your answer
Previous volunteer experience?
Limit your response to 1 paragraphs or less
Your answer
What is/are your reason(s) for volunteering?
Limit your response to 2 paragraphs or less
Your answer
Desirable times for you to volunteer?
Select all that apply. Time slots are not absolute. For example, if you are available from 2pm to 5pm, you can select 3pm to 6pm.
Required
In an emergency notify
Name, Telephone Number
Your answer
I hereby certify that I have read and understood all statements and questions on this application and my responses are true and complete to the best of my knowledge. I understand that any false representation, misstatement or omission may be basis for immediate dismissal.
Please type your initial below (e.g. if you are John Smith, you type JS)
Your answer
Please read the rules and regulations below carefully. If accepted as a hospital volunteer, I agree that:
1. My services are donated to the hospital for humanitarian, religious or charitable reasons. I expect no payment, benefits or future employment. I do not expect to receive the minimum wage or overtime for my services. 2. I will serve a minimum of 3 hours per week and commit to a schedule for at least 3 months. I will serve at least 1 year. 3. If unable to come in on my assigned day or time I will contact the Manager of Volunteers to inform and reschedule to make up the lost time. I understand that 3 unexcused absences is cause for terminating my membership as a volunteer. I also understand that failure to notify the department of an absence is considered unexcused absence. 4. I am willing to serve wherever I am needed at the hospital. 5. I understand that I will be taking orders and following directions from Adult Volunteer members, Junior Ambassadors, hospital personnel, Administration and other staff. (If you have difficulty doing this, you should reconsider serving as a volunteer) 6. I understand that only white pants or skirts, white shirt and volunteer jacket are to be worn while on duty and that my appearance will be neat and clean. If you are assigned to volunteer in a specific department, you may be assigned a different uniform. 7. I shall submit to examinations including TB screen, drug screening and blood test, as well as an annual flu shot that are necessary as part of my volunteer service. I authorize the person taking the tests to report the results to Regional Medical Center of San Jose. 8. I shall be punctual, conscientious and endeavor to make my work and conduct professional in quality. I will attempt to resolve any problems related to my volunteer activities with the Manager of Volunteers. 9. I shall at all times uphold the philosophy and standards of the hospital. 10. I understand that the Volunteer Services Department reserves the right to terminate my volunteer status in their own sole discretion at any time.
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